NPIMap

Organization Active NPI

Family Medicine Partership

  • Adult Health Nurse Practitioner
  • Bolton, CT
National Provider Identifier
1992132161
Registry record updated Oct 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Health Nurse PractitionerTaxonomy code 363LA2200X
License
5515 Issued in CT
Legal business name
FAMILY MEDICINE PARTERSHIP
Practice address
921 Boston Tpke
Ste a
Bolton, CT 06043-7403
Phone
(860) 646-0649
Fax
(860) 649-1995
NPI assigned
Oct 3, 2013
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Ronald Buckman, MDNPI 1871561092
Title
Owner
Phone
(860) 646-0649

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Health Nurse PractitionerGroup: 193400000X SINGLE SPECIALTY GROUP 363LA2200X 5515 CT Primary

Addresses

Primary practice location

921 Boston Tpke
Ste a
Bolton, CT 06043-7403

Mailing address

921 Boston Tpke
Ste a
Bolton, CT 06043-7403
Phone (860) 646-0649

Other identifiers 2

IdentifierTypeStateIssuer
004199825MedicaidCT
0308497007OtherCTCONNECTICARE

Other names 1

  • Bolton Familyand Sports Medicine Doing business as

National Provider Directory

National Provider Directory

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1380758400000",
    "number": "1992132161",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "921 BOSTON TPKE",
            "address_2": "STE A",
            "city": "BOLTON",
            "state": "CT",
            "postal_code": "060437403",
            "telephone_number": "860-646-0649",
            "fax_number": "860-649-1995"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "921 BOSTON TPKE",
            "address_2": "STE A",
            "city": "BOLTON",
            "state": "CT",
            "postal_code": "060437403",
            "telephone_number": "860-646-0649",
            "fax_number": "860-649-1995"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY MEDICINE PARTERSHIP",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-10-03",
        "last_updated": "2013-10-03",
        "status": "A",
        "authorized_official_last_name": "BUCKMAN",
        "authorized_official_first_name": "RONALD",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "860-646-0649",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CT",
            "license": "5515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004199825",
            "state": "CT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CONNECTICARE",
            "identifier": "0308497007",
            "state": "CT"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bolton Familyand Sports Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Bolton, CT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.